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Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction

BACKGROUND: An association between uric acid (UA) and cardiovascular diseases, including heart failure (HF), has been reported. However, whether UA is a causal risk factor for HF is controversial. In particular, the prognostic value of lowering UA in patients with HF with preserved ejection fraction...

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Autores principales: Nishino, Masami, Egami, Yasuyuki, Kawanami, Shodai, Sugae, Hiroki, Ukita, Kohei, Kawamura, Akito, Nakamura, Hitoshi, Matsuhiro, Yutaka, Yasumoto, Koji, Tsuda, Masaki, Okamoto, Naotaka, Matsunaga‐Lee, Yasuharu, Yano, Masamichi, Tanouchi, Jun, Yamada, Takahisa, Yasumura, Yoshio, Tamaki, Shunsuke, Hayashi, Takaharu, Nakagawa, Akito, Nakagawa, Yusuke, Sotomi, Yohei, Nakatani, Daisaku, Hikoso, Shungo, Sakata, Yasushi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673694/
https://www.ncbi.nlm.nih.gov/pubmed/36129035
http://dx.doi.org/10.1161/JAHA.122.026301
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author Nishino, Masami
Egami, Yasuyuki
Kawanami, Shodai
Sugae, Hiroki
Ukita, Kohei
Kawamura, Akito
Nakamura, Hitoshi
Matsuhiro, Yutaka
Yasumoto, Koji
Tsuda, Masaki
Okamoto, Naotaka
Matsunaga‐Lee, Yasuharu
Yano, Masamichi
Tanouchi, Jun
Yamada, Takahisa
Yasumura, Yoshio
Tamaki, Shunsuke
Hayashi, Takaharu
Nakagawa, Akito
Nakagawa, Yusuke
Sotomi, Yohei
Nakatani, Daisaku
Hikoso, Shungo
Sakata, Yasushi
author_facet Nishino, Masami
Egami, Yasuyuki
Kawanami, Shodai
Sugae, Hiroki
Ukita, Kohei
Kawamura, Akito
Nakamura, Hitoshi
Matsuhiro, Yutaka
Yasumoto, Koji
Tsuda, Masaki
Okamoto, Naotaka
Matsunaga‐Lee, Yasuharu
Yano, Masamichi
Tanouchi, Jun
Yamada, Takahisa
Yasumura, Yoshio
Tamaki, Shunsuke
Hayashi, Takaharu
Nakagawa, Akito
Nakagawa, Yusuke
Sotomi, Yohei
Nakatani, Daisaku
Hikoso, Shungo
Sakata, Yasushi
author_sort Nishino, Masami
collection PubMed
description BACKGROUND: An association between uric acid (UA) and cardiovascular diseases, including heart failure (HF), has been reported. However, whether UA is a causal risk factor for HF is controversial. In particular, the prognostic value of lowering UA in patients with HF with preserved ejection fraction (HFpEF) is unclear. METHODS AND RESULTS: We enrolled patients with HFpEF from the PURSUIT‐HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction) registry. We investigated whether UA was correlated with the composite events, including all‐cause mortality and HF rehospitalization, in patients with hyperuricemia and HFpEF (UA >7.0 mg/dL). Additionally, we evaluated whether lowering UA for 1 year (≥1.0 mg/dL) in them reduced mortality or HF rehospitalization. We finally analyzed 464 patients with hyperuricemia. In multivariable Cox regression analysis, UA was an independent determinant of composite death and rehospitalization (hazard ratio [HR], 1.15 [95% CI, 1.03–1.27], P=0.015). We divided them into groups with severe and mild hyperuricemia according to median estimated value of serum UA (8.3 mg/dL). Cox proportional hazards models revealed the incidence of all‐cause mortality was significantly higher in the group with severe hyperuricemia than in the group with mild hyperuricemia (HR, 1.73 [95% CI, 1.19–2.25], P=0.004). The incidence of all‐cause mortality was significantly decreased in the group with lowering UA compared with the group with nonlowering UA (HR, 1.71 [95% CI, 1.02–2.86], P=0.041). The incidence of urate‐lowering therapy tended to be higher in the group with lowering UA than in the group with nonlowering UA (34.9% versus 24.6%, P=0.06). CONCLUSIONS: UA is a predictor for the composite of all‐cause death and HF rehospitalization in patients with hyperuricemia and HFpEF. In these patients, lowering UA, including the use of urate‐lowering therapy, may improve prognosis.
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spelling pubmed-96736942022-11-21 Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction Nishino, Masami Egami, Yasuyuki Kawanami, Shodai Sugae, Hiroki Ukita, Kohei Kawamura, Akito Nakamura, Hitoshi Matsuhiro, Yutaka Yasumoto, Koji Tsuda, Masaki Okamoto, Naotaka Matsunaga‐Lee, Yasuharu Yano, Masamichi Tanouchi, Jun Yamada, Takahisa Yasumura, Yoshio Tamaki, Shunsuke Hayashi, Takaharu Nakagawa, Akito Nakagawa, Yusuke Sotomi, Yohei Nakatani, Daisaku Hikoso, Shungo Sakata, Yasushi J Am Heart Assoc Original Research BACKGROUND: An association between uric acid (UA) and cardiovascular diseases, including heart failure (HF), has been reported. However, whether UA is a causal risk factor for HF is controversial. In particular, the prognostic value of lowering UA in patients with HF with preserved ejection fraction (HFpEF) is unclear. METHODS AND RESULTS: We enrolled patients with HFpEF from the PURSUIT‐HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction) registry. We investigated whether UA was correlated with the composite events, including all‐cause mortality and HF rehospitalization, in patients with hyperuricemia and HFpEF (UA >7.0 mg/dL). Additionally, we evaluated whether lowering UA for 1 year (≥1.0 mg/dL) in them reduced mortality or HF rehospitalization. We finally analyzed 464 patients with hyperuricemia. In multivariable Cox regression analysis, UA was an independent determinant of composite death and rehospitalization (hazard ratio [HR], 1.15 [95% CI, 1.03–1.27], P=0.015). We divided them into groups with severe and mild hyperuricemia according to median estimated value of serum UA (8.3 mg/dL). Cox proportional hazards models revealed the incidence of all‐cause mortality was significantly higher in the group with severe hyperuricemia than in the group with mild hyperuricemia (HR, 1.73 [95% CI, 1.19–2.25], P=0.004). The incidence of all‐cause mortality was significantly decreased in the group with lowering UA compared with the group with nonlowering UA (HR, 1.71 [95% CI, 1.02–2.86], P=0.041). The incidence of urate‐lowering therapy tended to be higher in the group with lowering UA than in the group with nonlowering UA (34.9% versus 24.6%, P=0.06). CONCLUSIONS: UA is a predictor for the composite of all‐cause death and HF rehospitalization in patients with hyperuricemia and HFpEF. In these patients, lowering UA, including the use of urate‐lowering therapy, may improve prognosis. John Wiley and Sons Inc. 2022-09-21 /pmc/articles/PMC9673694/ /pubmed/36129035 http://dx.doi.org/10.1161/JAHA.122.026301 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Nishino, Masami
Egami, Yasuyuki
Kawanami, Shodai
Sugae, Hiroki
Ukita, Kohei
Kawamura, Akito
Nakamura, Hitoshi
Matsuhiro, Yutaka
Yasumoto, Koji
Tsuda, Masaki
Okamoto, Naotaka
Matsunaga‐Lee, Yasuharu
Yano, Masamichi
Tanouchi, Jun
Yamada, Takahisa
Yasumura, Yoshio
Tamaki, Shunsuke
Hayashi, Takaharu
Nakagawa, Akito
Nakagawa, Yusuke
Sotomi, Yohei
Nakatani, Daisaku
Hikoso, Shungo
Sakata, Yasushi
Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title_full Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title_fullStr Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title_full_unstemmed Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title_short Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
title_sort lowering uric acid may improve prognosis in patients with hyperuricemia and heart failure with preserved ejection fraction
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673694/
https://www.ncbi.nlm.nih.gov/pubmed/36129035
http://dx.doi.org/10.1161/JAHA.122.026301
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